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Ahmad FA, Jeffe DB, Plax K, Schechtman KB, Doerhoff DE, Garbutt JM, Jaffe DM. Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department. J Accid Emerg Med 2018. [DOI: https:/doi:10.1136/emermed-2016-206199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectivesAdolescents and young adults are at high risk for sexually transmitted infections (STIs). We previously reported an increase in STI testing of adolescents in our ED by obtaining a sexual history using an Audio-enhanced Computer-Assisted Self-Interview (ACASI). We now examine associations among demographics, sexual behaviour, chief complaint and willingness to be tested.MethodsThis was a prospective study conducted in a paediatric ED between April and December 2011. After triage, eligible patients between 15 and 21 years presenting with non-life-threatening conditions were asked to participate in the study. Consenting participants used an ACASI to provide their demographic data and answer questions about their sexual history and willingness to be tested. Our primary outcome was the association of demographics, chief complaint and ACASI recommendation with the participant’s willingness to be tested.ResultsWe approached 1337 patients, of whom 800 (59%) enrolled and completed the ACASI. Eleven who did not answer questions related to their sexual history were excluded from analysis. Of 789 participants, 461 (58.4%) were female and median age was 16.9 years (IQR 16.0–17.8); 509 (64.5%) endorsed a history of anal, oral and/or vaginal intercourse. Disclosing a sexual history and willingness to be tested did not differ significantly by gender. 131 (16.6%) had a chief complaint potentially referable to an STI; among the 658 participants with non-STI-related complaints, 412 (62.6%) were sexually active, many of whom disclosed risky behaviours, including multiple partners (46.4%) and inconsistent condom use (43.7%). The ACASI identified 419 patients as needing immediate STI testing; the majority (81%) did not have a chief complaint potentially related to STIs. 697 (88.3%) participants were willing to receive STI testing. Most (94.6%) of the patients with STI-related complaints were willing to be tested, and 92.1% of patients with a recommendation for immediate testing by the ACASI indicated a willingness to be tested.ConclusionsAdolescents were willing to disclose sexual activity via electronic questionnaires and were willing to receive STI testing, even when their chief complaint was not STI related. The ACASI facilitated identification of adolescent ED patients needing STI testing regardless of chief complaint.
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Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Association Between Adolescent Preventive Care and the Role of the Affordable Care Act. JAMA Pediatr 2018; 172:43-48. [PMID: 29114725 PMCID: PMC5833515 DOI: 10.1001/jamapediatrics.2017.3140] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/18/2017] [Indexed: 11/14/2022]
Abstract
Importance Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates. Objectives To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers' reports of past-year preventive services delivery increased from the pre- to post-ACA period among adolescents with any past-year health care visit. Design, Setting, and Participants Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25 695 10- to 17-year-old adolescents). Main Outcomes and Measures For objective 1, pre- to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre- to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables. Results A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre- and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases. Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when controlling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI, 1.0-1.3). Conclusions and Relevance Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.
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Affiliation(s)
- Sally H. Adams
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - M. Jane Park
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
| | - Claire D. Brindis
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
- Philip R. Lee Institute for Health Policy Studies,
University of California, San Francisco
| | - Charles E. Irwin
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California,
San Francisco
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103
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Cartmell KB, Young-Pierce J, McGue S, Alberg AJ, Luque JS, Zubizarreta M, Brandt HM. Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment to inform action. ACTA ACUST UNITED AC 2017; 5:21-31. [PMID: 29248818 PMCID: PMC5886972 DOI: 10.1016/j.pvr.2017.11.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/08/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to investigate how state level strategies in South Carolina could maximize HPV vaccine uptake. DESIGN An environmental scan identified barriers, facilitators, and strategies for improving HPV vaccination in South Carolina. Interviews were conducted with state leaders from relevant organizations such as public health agencies, medical associations, K-12 schools, universities, insurers, and cancer advocacy organizations. A thematic content analysis design was used. Digital interview files were transcribed, a data dictionary was created and data were coded using the data dictionary. RESULTS Thirty four interviews were conducted with state leaders. Barriers to HPV vaccination included lack of HPV awareness, lack of provider recommendation, HPV vaccine concerns, lack of access and practice-level barriers. Facilitators included momentum for improving HPV vaccination, school-entry Tdap requirement, pharmacy-based HPV vaccination, state immunization registry, HEDIS measures and HPV vaccine funding. Strategies for improving HPV vaccination fell into three categories: 1) addressing lack of awareness about the importance of HPV vaccination among the public and providers; 2) advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination; and 3) coordination of efforts. DISCUSSION A statewide environmental scan generated a blueprint for action to be used to improve HPV vaccination in the state.
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Affiliation(s)
- Kathleen B Cartmell
- Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, United States; Medical University of South Carolina, College of Nursing, Charleston, SC, United States.
| | - Jennifer Young-Pierce
- Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, United States; Medical University of South Carolina, Department of Gynecologic Oncology, Charleston, SC, United States
| | - Shannon McGue
- Medical University of South Carolina, College of Medicine, Charleston, SC, United States
| | - Anthony J Alberg
- Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, United States; Medical University of South Carolina, Department of Public Health Sciences, United States
| | - John S Luque
- Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, United States; Medical University of South Carolina, Department of Public Health Sciences, United States
| | - Maria Zubizarreta
- University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Heather M Brandt
- University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
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104
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McRee AL, Mays D, Kornides ML, Gilkey MB. Counseling About Skin Cancer Prevention Among Adolescents: What Do Parents Receive From Health Care Providers? J Adolesc Health 2017; 61:533-536. [PMID: 28732717 PMCID: PMC5722459 DOI: 10.1016/j.jadohealth.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Adolescence is a high-risk period for ultraviolet radiation exposure, a primary cause of skin cancer later in life. We sought to characterize receipt of health care provider-delivered counseling about skin cancer prevention (SCP) among parents of adolescents. METHODS In 2016, we conducted an online survey with a national sample of parents of adolescents aged 11-17 years (n = 1,253). Multivariable logistic regression assessed correlates of receiving counseling from a health care provider about any of the six skin cancer prevention (SCP) topics. RESULTS Only half (49%) of parents recalled discussing any SCP topic with their child's provider; the prevalence was highest for sunscreen (39%) and lowest for indoor tanning (3%). Parents had greater odds of receiving counseling if they had a child with more sun-reactive skin (odds ratio [OR] = 1.53); a family history of skin cancer (OR = 1.38); or a higher quality relationship with the provider (OR = 1.47; all p < .05). CONCLUSIONS Greater attention to SCP counseling is needed, especially for exposures such as indoor tanning that remain prevalent among adolescents but are rarely addressed in clinical encounters.
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Affiliation(s)
- Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Melissa B Gilkey
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
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105
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Miller MK, Pickett ML, Reed JL. Adolescents at Risk for Sexually Transmitted Infection Need More Than the Right Medicine. J Pediatr 2017; 189:23-25. [PMID: 28739182 DOI: 10.1016/j.jpeds.2017.06.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa K Miller
- Division of Emergency Medicine Children's Mercy Hospital Kansas City, Missouri.
| | - Michelle L Pickett
- Division of Emergency Medicine Children's Hospital of Wisconsin Milwaukee, Wisconsin
| | - Jennifer L Reed
- Division of Emergency Services Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio
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106
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Haley SJ, Moscou S, Murray S, Rieckmann T, Wells K. The Availability of Alcohol, Tobacco, and Other Drug Services for Adolescents in New York State Community Health Centers. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617731132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescent experimentation with alcohol, tobacco, or other drugs is commonplace, and limited access to screening and treatment services poses a significant public health risk. This study identified alcohol, tobacco, and other drug services available for adolescents at community health center sites in New York. A survey was distributed to medical and behavioral health directors across 54 community health center organizations serving 255 primary care adolescent sites. One third of sites required adolescent screening for substance use disorders (SUDs). Twenty-eight percent of sites said all/nearly all (80%-100%) and 12% said most (60%-79%) adolescents actually were screened. On-site tobacco cessation treatment and substance abuse counseling were offered at 53% and 14% of sites, respectively. Multilevel models suggested that community health center organizations positively influenced sites’ adolescent SUD screening and tobacco treatment. Additional investment in adolescent behavioral health screening and treatment is needed to reduce alcohol, illicit drug, or tobacco use among the underserved.
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Affiliation(s)
| | | | | | | | - Kameron Wells
- Community Health Care Association of New York State, NY, NY, USA
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107
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Daley AM, Polifroni EC, Sadler LS. "Treat Me Like a Normal Person!" A Meta-Ethnography of Adolescents' Expectations of Their Health Care Providers. J Pediatr Nurs 2017; 36:70-83. [PMID: 28888515 DOI: 10.1016/j.pedn.2017.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 04/04/2017] [Accepted: 04/24/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Preventive health care services provide an important opportunity to assist adolescents to establish and maintain a healthy lifestyle and assume an increasing independent role in their health care. National guidelines emphasize the importance of an annual wellness visit to identify and address risk-behaviors that contribute significantly to the morbidity and mortality in this population. Despite these recommendations, adolescents utilize preventive health care at declining rates throughout adolescence. The purpose of this study was to capture a more holistic view of what adolescents, as consumers of health care services, expect from their primary health care providers (HCPs). METHOD A metasynthesis of 12 qualitative research studies was conducted using Noblit and Hare's (1988) meta-ethnographic approach. RESULTS Five overarching metaphors, Talk with Me- Not at Me, Accept Me, Respect My Privacy and Confidentiality, Show Me You Are a Professional, and A Trusted Relationship described adolescents' expectations of their HCPs. CONCLUSIONS This study provides a more holistic view of adolescents' expectations of their HCPs. Clinical strategies are suggested to assist HCPs to meet adolescents' expectations.
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Affiliation(s)
- Alison Moriarty Daley
- Associate Professor, Yale University School of Nursing, West Haven, CT and Pediatric Nurse Practitioner, Yale-New Haven Hospital Hill Regional Career High School School-Based Health Center, New Haven, CT.
| | - E Carol Polifroni
- Professor and Dean, University of Connecticut School of Nursing, Storrs, CT
| | - Lois S Sadler
- Professor, Yale University School of Nursing, West Haven, CT and Yale Child Study Center, New Haven, CT
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108
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Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents. Acad Pediatr 2017; 17:S108-S114. [PMID: 28865641 DOI: 10.1016/j.acap.2017.01.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/13/2016] [Accepted: 01/15/2017] [Indexed: 01/23/2023]
Abstract
Adolescents exposed to adverse childhood experiences (ACEs) have unique developmental needs that must be addressed by the health, education, and social welfare systems that serve them. Nationwide, over half of adolescents have reportedly been exposed to ACEs. This exposure can have detrimental effects, including increased risk for learning and behavioral issues and suicidal ideation. In response, clinical and community systems need to carefully plan and coordinate services to support adolescents who have been exposed to ACEs, with a particular focus on special populations. We discuss how adolescents' needs can be met, including considering confidentiality concerns and emerging independence; tailoring and testing screening tools for specific use with adolescents; identifying effective multipronged and cross-system trauma-informed interventions; and advocating for improved policies.
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109
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Webb MJ, Wadley G, Sanci LA. Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study. JMIR Mhealth Uhealth 2017; 5:e118. [PMID: 28801302 PMCID: PMC5573432 DOI: 10.2196/mhealth.7816] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/03/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care. Objective The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care. Methods This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. Results The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration. Conclusions Integrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.
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Affiliation(s)
- Marianne Julie Webb
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, University of Melbourne, Parkville, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Lena Amanda Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, University of Melbourne, Parkville, Australia
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110
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Ahmad FA, Jeffe DB, Plax K, Schechtman KB, Doerhoff DE, Garbutt JM, Jaffe DM. Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department. Emerg Med J 2017; 35:46-51. [PMID: 28801483 DOI: 10.1136/emermed-2016-206199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 06/20/2017] [Accepted: 07/12/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Adolescents and young adults are at high risk for sexually transmitted infections (STIs). We previously reported an increase in STI testing of adolescents in our ED by obtaining a sexual history using an Audio-enhanced Computer-Assisted Self-Interview (ACASI). We now examine associations among demographics, sexual behaviour, chief complaint and willingness to be tested. METHODS This was a prospective study conducted in a paediatric ED between April and December 2011. After triage, eligible patients between 15 and 21 years presenting with non-life-threatening conditions were asked to participate in the study. Consenting participants used an ACASI to provide their demographic data and answer questions about their sexual history and willingness to be tested. Our primary outcome was the association of demographics, chief complaint and ACASI recommendation with the participant's willingness to be tested. RESULTS We approached 1337 patients, of whom 800 (59%) enrolled and completed the ACASI. Eleven who did not answer questions related to their sexual history were excluded from analysis. Of 789 participants, 461 (58.4%) were female and median age was 16.9 years (IQR 16.0-17.8); 509 (64.5%) endorsed a history of anal, oral and/or vaginal intercourse. Disclosing a sexual history and willingness to be tested did not differ significantly by gender. 131 (16.6%) had a chief complaint potentially referable to an STI; among the 658 participants with non-STI-related complaints, 412 (62.6%) were sexually active, many of whom disclosed risky behaviours, including multiple partners (46.4%) and inconsistent condom use (43.7%). The ACASI identified 419 patients as needing immediate STI testing; the majority (81%) did not have a chief complaint potentially related to STIs. 697 (88.3%) participants were willing to receive STI testing. Most (94.6%) of the patients with STI-related complaints were willing to be tested, and 92.1% of patients with a recommendation for immediate testing by the ACASI indicated a willingness to be tested. CONCLUSIONS Adolescents were willing to disclose sexual activity via electronic questionnaires and were willing to receive STI testing, even when their chief complaint was not STI related. The ACASI facilitated identification of adolescent ED patients needing STI testing regardless of chief complaint.
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Affiliation(s)
- Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna B Jeffe
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katie Plax
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Jane M Garbutt
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David M Jaffe
- American Academy of Pediatrics, Chicago, Illinois, USA
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111
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Ascione F, Cascone D, Napolitano F, Di Giuseppe G. Evaluation of the use of health care services for non-communicable disease and prevention by children and adolescents in south Italy. BMC Health Serv Res 2017; 17:532. [PMID: 28778162 PMCID: PMC5545043 DOI: 10.1186/s12913-017-2489-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/01/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The objectives of this investigation are to evaluate the use of health care services for non-communicable disease and prevention by children and adolescents and to identify the factors linked to the use of health care services. METHODS This cross-sectional survey was conducted between December 2014 and January 2015 among 1198 parents of students aged between 5 and 18 years attending 12 selected schools in the geographic area of Salerno and Naples, Italy, using a self-administered questionnarie. RESULTS 68.2% of parents stated that had visited their general practitioner (GP) or family pediatrician (FP) with their child in the last year. 66.2% of children had had at least one visit to a specialist and more than half (54.8%) had had preventive care visits in the last year. The use of preventive care visits within last year was significantly higher amongst female, among those who had visited their GP or FP and among those who had a parent with a college degree or higher. The proportion of emergency department visits and hospital admissions reported were 12.8% and 4.7% respectively. CONCLUSION This results highlights the need of educational interventions for parents and adolescents in order to increase the utilization of preventive health services.
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Affiliation(s)
- Flora Ascione
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Diana Cascone
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
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112
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Zieve GG, Richardson LP, Katzman K, Spielvogle H, Whitehouse S, McCarty CA. Adolescents' Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study. J Med Internet Res 2017; 19:e261. [PMID: 28729236 PMCID: PMC5544900 DOI: 10.2196/jmir.7474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/23/2017] [Accepted: 05/25/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Electronic health screening tools for primary care present an opportunity to go beyond data collection to provide education and feedback to adolescents in order to motivate behavior change. However, there is limited research to guide feedback message development. OBJECTIVE The aim of this study was to explore youth perceptions of and preferences for receiving personalized feedback for multiple health risk behaviors and reinforcement for health promoting behaviors from an electronic health screening tool for primary care settings, using qualitative methodology. METHODS In total, 31 adolescents aged 13-18 years completed the screening tool, received the electronic feedback, and subsequently participated in individual, semistructured, qualitative interviews lasting approximately 60 min. Participants were queried about their overall impressions of the tool, perceptions regarding various types of feedback messages, and additional features that would help motivate health behavior change. Using thematic analysis, interview transcripts were coded to identify common themes expressed across participants. RESULTS Overall, the tool was well-received by participants who perceived it as a way to enhance-but not replace-their interactions with providers. They appreciated receiving nonjudgmental feedback from the tool and responded positively to information regarding the consequences of behaviors, comparisons with peer norms and health guidelines, tips for behavior change, and reinforcement of healthy choices. A small but noteworthy minority of participants dismissed the peer norms as not real or relevant and national guidelines as not valid or reasonable. When prompted for possible adaptations to the tool, adolescents expressed interest in receiving follow-up information, setting health-related goals, tracking their behaviors over time, and communicating with providers electronically between appointments. CONCLUSIONS Adolescents in this qualitative study desired feedback that validates their healthy behavior choices and supports them as independent decision makers by neutrally presenting health information, facilitating goal setting, and offering ongoing technological supports.
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Affiliation(s)
- Garret G Zieve
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Heather Spielvogle
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Sandy Whitehouse
- Division of Adolescent Medicine, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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113
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Osier E, Wang AS, Tollefson MM, Cordoro KM, Daniels SR, Eichenfield A, Gelfand JM, Gottlieb AB, Kimball AB, Lebwohl M, Mehta NN, Paller AS, Schwimmer JB, Styne DM, Van Voorhees AS, Tom WL, Eichenfield LF. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol 2017; 153:698-704. [PMID: 28514463 PMCID: PMC5748031 DOI: 10.1001/jamadermatol.2017.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health. Objective To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. Evidence Review A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence. Findings Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation. Conclusions and Relevance Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.
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Affiliation(s)
- Emily Osier
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | - Audrey S Wang
- Division of Dermatology, Sharp Rees-Stealy Medical Group, San Diego, California
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Kelly M Cordoro
- Division of Pediatric Dermatology, Department of Dermatology, University of California San Francisco, San Francisco
| | - Stephen R Daniels
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Andrew Eichenfield
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Mark Lebwohl
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Nehal N Mehta
- Division of Intramural Research, Section of Inflammation and Cardiometabolic Diseases, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego
| | - Dennis M Styne
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
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Hickman NE, Schaar G. Impact of an Educational Text Message Intervention on Adolescents’ Knowledge and High-Risk Behaviors. Compr Child Adolesc Nurs 2017; 41:71-82. [DOI: 10.1080/24694193.2017.1323979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nichole Erin Hickman
- Riley Physicians, Indiana University Health, Bloomington, Indiana, USA
- University of Southern Indiana, Evansville, Indiana, USA
| | - Gina Schaar
- University of Southern Indiana, Evansville, Indiana, USA
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115
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Adjei Boakye E, Tobo BB, Osazuwa-Peters N, Mohammed KA, Geneus CJ, Schootman M. A Comparison of Parent- and Provider-Reported Human Papillomavirus Vaccination of Adolescents. Am J Prev Med 2017; 52:742-752. [PMID: 27890518 DOI: 10.1016/j.amepre.2016.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/22/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is considerable effort at the state and national levels to monitor human papillomavirus (HPV) vaccine uptake and understand the factors that influence who gets vaccinated. Accurate measurement of vaccination coverage is critical for monitoring HPV vaccination. This study aimed to determine comparability between parent- and provider-reported HPV vaccination status for a sample of adolescents in the U.S. METHODS Data from the 2014 National Immunization Survey-Teen were analyzed in 2016 for 20,827 adolescents. Information on HPV vaccine uptake (initiation [one or more dose] and completion [three or more doses]) was obtained using parental (recall) and provider reports (electronic medical records). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and κ-coefficient were computed to determine how comparable parental and provider (ref group) reports were for HPV vaccination. RESULTS Prevalence of HPV vaccine initiation was comparable between parental and provider report (51.3% vs 50.0%) and for completion (30.7% vs 27.3%). Compared with provider report, parent-reported HPV vaccine initiation had high sensitivity (86.0%), specificity (87.4%), PPV (87.5%), NPV (85.9%), and acceptable κ-coefficient (0.73). Compared with provider report, parent-reported HPV vaccine completion had a sensitivity of 71.5%, specificity of 91.1%, PPV of 78.5%, NPV of 87.6%, and κ-coefficient of 0.64. Similar characteristics-adolescent age, sex, number of doctor visits, and region-were associated with HPV vaccine uptake using parental and provider reports. CONCLUSIONS Parental recall is comparable to provider report in monitoring HPV vaccine uptake for adolescents, although parental recall is less comparable for HPV vaccine completion.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Outcomes Research, Saint Louis University, Saint Louis, Missouri
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri; Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, Missouri; Saint Louis University Cancer Center, Saint Louis, Missouri
| | - Kahee A Mohammed
- Saint Louis University Center for Outcomes Research, Saint Louis University, Saint Louis, Missouri
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri.
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116
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Kumra T, Antani S, Johnson SB, Weaver SJ. Improving Adolescent Preventive Care in an Urban Pediatric Clinic: Capturing Missed Opportunities. J Adolesc Health 2017; 60:734-740. [PMID: 28259619 DOI: 10.1016/j.jadohealth.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/23/2016] [Accepted: 01/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To increase the proportion of adolescents with Medicaid who receive preventive care services in an urban pediatric clinic. METHODS A quality improvement intervention was implemented at an urban pediatric primary care clinic between November 2013 and October 2014. The intervention systematically "flipped" acute visits into well-care visits for patients ages 12-21 years, when overdue. The primary process measure was the percentage of acute visits expanded to include well-care components out of total eligible opportunities. The primary outcome measure was adolescent well-care (AWC) completion in 2014 versus 2013 and 2012. RESULTS Among 857 adolescents with Medicaid, 124 additional AWC visits were completed by October 2014 compared to 2013 and 71 additional visits compared to 2012. The gap to achieving Healthcare Effectiveness Data and Information Set neutral zone targets for AWC was reduced by 59% compared to 2013 and by 54% compared to 2012. The mean proportion of eligible acute opportunities "flipped" monthly increased from 17% (range: 10%-21%) during the initial 3 months of implementation to 30% (range: 5%-50%) in the last 3 months. CONCLUSIONS Systematically flipping acute visits into well visits resulted in reaching Healthcare Effectiveness Data and Information Set quality targets for AWC, which had not previously been accomplished by this clinic. Incorporating staff and provider feedback strengthened intervention fidelity and buy-in despite time constraints in a busy, urban setting.
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Affiliation(s)
- Tina Kumra
- Johns Hopkins Community Physicians, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
| | - Shweta Antani
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sallie J Weaver
- Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Upadhya KK, Santelli JS, Raine-Bennett TR, Kottke MJ, Grossman D. Over-the-Counter Access to Oral Contraceptives for Adolescents. J Adolesc Health 2017; 60:634-640. [PMID: 28314704 DOI: 10.1016/j.jadohealth.2016.12.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/18/2022]
Abstract
Oral contraceptives (OCs) are used by millions of women in the U.S. The requirement to obtain OCs by prescription from a clinician may serve as a barrier to contraceptive initiation and continuation for women, in particular adolescents. Over-the-counter (OTC) availability would reduce this barrier and could further reduce unintended pregnancy rates. This review explores the scientific issues and regulatory processes involved in switching OCs to OTC status for minor adolescents. We review: (1) the regulatory criteria for switching a drug to OTC status; (2) risk of pregnancy and safety during use of OCs including combined oral contraceptives and progestin-only pills for adolescents; (3) the ability of adolescents to use OCs consistently and correctly; (4) OTC access to OCs and potential effect on sexual risk behaviors; and (5) the potential for reduced opportunities for clinicians to counsel and provide recommended reproductive health care to adolescents. We find strong scientific rationale for including adolescents in any regulatory change to switch OCs to OTC status. OCs are safe and highly effective among adolescents; contraindications are rarer among adolescents compared to adult women. Ready access to OCs, condoms, and emergency contraception increases their use without increasing sexual risk behaviors.
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Affiliation(s)
- Krishna K Upadhya
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Tina R Raine-Bennett
- Division of Research & Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | - Melissa J Kottke
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Daniel Grossman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California San Francisco, Oakland, California
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118
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Reed JL, Punches BE, Taylor RG, Macaluso M, Alessandrini EA, Kahn JA. A Qualitative Analysis of Adolescent and Caregiver Acceptability of Universally Offered Gonorrhea and Chlamydia Screening in the Pediatric Emergency Department. Ann Emerg Med 2017; 70:787-796.e2. [PMID: 28559031 DOI: 10.1016/j.annemergmed.2017.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE We qualitatively explore adolescent and parent or guardian attitudes about benefits and barriers to universally offered gonorrhea and chlamydia screening and modalities for assessing interest in screening in the pediatric emergency department (ED). METHODS A convenience sample of forty 14- to 21-year-olds and parents or guardians of adolescents presenting to an urban and community pediatric ED with any chief complaint participated in individual, semistructured, confidential interviews. Topics included support of universally offered gonorrhea and chlamydia screening, barriers and benefits to screening, and modalities for assessing interest in screening. Data were analyzed with framework analysis. RESULTS Almost all adolescents (37/40; 93%) and parents (39/40; 98%) support offering ED gonorrhea or chlamydia screening. Benefits included earlier diagnosis and treatment, convenience and transmission prevention (cited by both groups), and improved education and long-term health (cited by parents/guardians). Barriers included concerns about confidentiality and cost (cited by both groups), embarrassment (cited by adolescents), and nondisclosure to parents or guardians (cited by parents/guardians). Adolescents preferred that the request for gonorrhea or chlamydia screening be presented in a private room, using tablet technology. Both groups noted that the advantages to tablets included confidentiality and adolescents' familiarity with technology. Adolescents noted that tablet use would address concerns about bringing up gonorrhea or chlamydia screening with clinicians, whereas parents or guardians noted that tablets might increase screening incidence but expressed concern about the lack of personal interaction. CONCLUSION Universally offered gonorrhea and chlamydia screening in a pediatric ED was acceptable to the adolescents and parents or guardians in this study. Offering a tablet-based method to assess interest in screening may increase participation.
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Affiliation(s)
- Jennifer L Reed
- Division of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Brittany E Punches
- Cincinnati Children's Hospital Medical Center and Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Regina G Taylor
- Division of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Evaline A Alessandrini
- Division of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH; James M. Anderson Center for Health Systems Excellence, University of Cincinnati Medical Center, Cincinnati, OH
| | - Jessica A Kahn
- Division of Adolescent and Transition Medicine, University of Cincinnati Medical Center, Cincinnati, OH
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Masoumi M, Shahhosseini Z. Self-care challenges in adolescents: a comprehensive literature review. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2016-0152/ijamh-2016-0152.xml. [PMID: 28599383 DOI: 10.1515/ijamh-2016-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/21/2017] [Indexed: 11/15/2022]
Abstract
Background Adolescence is the period of accepting self-care responsibility. Many severe diseases that cause early mortality are rooted in adolescence. Hence, adolescence is the definitive time for preventive interventions such as self-care behaviors. In addition to the benefits of self-care behaviors, evidence shows that adolescents face barriers in performing self-care behaviors. Objective The aim of the current study to review the self-care challenges for adolescents. Methods Databases such as Google Scholar, ScienceDirect, PubMed, Web of Science, Scientific Information Database and Scopus were searched to extract papers published from 1994 to 2016 based on the inclusion criterion. The inclusion criterion was English language papers from famous authors on self-care behaviors in adolescents. Results The results of the current study showed that adolescents face cultural (two subcategories, beliefs and convictions, knowledge), socio-economic (five subcategories, family, healthcare providers, peers, social support, economic status) and personal (three subcategories, mental health, gender, ethnicity) challenges. Conclusions Self-care behaviors in adolescents are influenced by biological, psychological, economic and social factors. As this is a multifactorial process, people who deal with adolescents should have enough knowledge regarding adolescent health status and also learn how to perceive the role of culture in self-care behaviors of the adolescents.
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Affiliation(s)
- Maryam Masoumi
- Research Student Committee, Mazandaran University of Medical Science, Nasibeh Nursing and Midwifery Faculty,Sari, Iran
| | - Zohreh Shahhosseini
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty,Mazandaran University of Medical Sciences, Sari, Iran
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Abstract
Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.
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Affiliation(s)
- Barbara K Snyder
- 1 Community Health Programs Health Center, Great Barrington, MA, USA
| | - Gail D Burack
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna Petrova
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
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Richards M, Teal SB, Sheeder J. Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants. Contraception 2017; 95:364-370. [DOI: 10.1016/j.contraception.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/20/2017] [Accepted: 01/28/2017] [Indexed: 12/01/2022]
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Nurses on the Front Lines: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings. Am J Nurs 2017; 117:42-51. [PMID: 28030408 DOI: 10.1097/01.naj.0000511566.12446.45] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.
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123
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Harris SK, Aalsma MC, Weitzman ER, Garcia-Huidobro D, Wong C, Hadland SE, Santelli J, Park MJ, Ozer EM. Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go? J Adolesc Health 2017; 60:249-260. [PMID: 28011064 PMCID: PMC5549464 DOI: 10.1016/j.jadohealth.2016.10.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/06/2016] [Accepted: 10/11/2016] [Indexed: 01/22/2023]
Abstract
We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care.
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Affiliation(s)
- Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Matthew C Aalsma
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Diego Garcia-Huidobro
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Charlene Wong
- Division of Adolescent Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John Santelli
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California; Office of Diversity and Outreach, University of California, San Francisco, San Francisco, California.
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Corathers SD, Kichler JC, Fino NF, Lang W, Lawrence JM, Raymond JK, Yi-Frazier JP, Dabelea D, Liese AD, Saydah SH, Seid M, Dolan LM. High health satisfaction among emerging adults with diabetes: Factors predicting resilience. Health Psychol 2017; 36:206-214. [PMID: 27736152 PMCID: PMC6296746 DOI: 10.1037/hea0000419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study was conducted to identify factors contributing to health satisfaction outcomes among emerging adults (ages 18-25) with diabetes. METHOD SEARCH for Diabetes in Youth study participants whose diabetes was prevalent in 2001 and were ≥18 years of age when they completed a 2008-2009 follow-up survey (n = 340) were included. We developed a health resilience model (HRM) to identify potentially modifiable factors (anticipatory guidance, social support, physical activity, quality of life) associated with health outcomes (satisfaction with health care, overall personal health, self-report of hemoglobin A1c [HbA1c]). Proportional odds logistic regression models were used to examine relationships between modifiable factors and health outcomes while adjusting for predetermined characteristics; linear regression models were used for reported HbA1c. Comparison of participants who reported HbA1c versus nonreporters was conducted. RESULTS A majority (70%) of participants rated satisfaction with health care ≥7 out of 10, and most (71%) rated overall health as good, very good, or excellent. Satisfaction with health care was independent of change in provider between the ages of 17 and 24. After controlling for predetermined characteristics, we found that the odds of increased satisfaction with health care and overall personal health were 1.3 and 1.2 greater, respectively, when participants discussed additional diabetes-related anticipatory guidance topics with a provider and 1.3 and 2.1, respectively, for each 10-unit change in quality of life score. Relationship between HbA1c level and modifiable factors was not significant; however, participants reporting HbA1c had higher ratings of health care and overall health versus nonreporters. CONCLUSIONS HRM describes relationships between modifiable factors and patient-reported outcomes of satisfaction with health care and overall personal health among a cohort of ethnically and racially diverse emerging adults with longstanding diabetes, over half of whom experienced a change in provider. HRM may discern candidate areas for intervention, such as effective anticipatory guidance that can impact satisfaction with health care and overall health, to promote positive health outcomes. (PsycINFO Database Record
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Affiliation(s)
| | - Jessica C Kichler
- Division of Behavioral Medicine and Clinical Psychology, Children's Hospital Medical Center
| | - Nora F Fino
- Department of Bio-statistical Sciences, Wake Forest School of Medicine
| | - Wei Lang
- Department of Bio-statistical Sciences, Wake Forest School of Medicine
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California
| | | | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health
| | | | - Sharon H Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention
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Sawni A, Cederna-Meko C, LaChance JL, Buttigieg A, Le Q, Nunuk I, Ang J, Burrell KM. Feasibility and Perceptions of Cell Phone-Based, Health-Related Communication With Adolescents in an Economically Depressed Area. Clin Pediatr (Phila) 2017; 56:140-145. [PMID: 27207867 DOI: 10.1177/0009922816645516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the feasibility and perception of cell-based (texting, voicemail [VM], and email/social media), health-related communication with adolescents in Genesee County, MI, where 22% reside below the poverty level. Results of an anonymous survey found that 86% of respondents owned a cell phone, 87% had data, 96% texted, 90.5% emailed/used social media, and 68% had VM. Most adolescents were interested in cell-based communication via texting (52%), VM (37%), and email/social media (31%). Interest in types of health communication included appointment reminders (99% texting; 94% VM; 95% email/social media), shot reminders (84.5% texting; 74.5% VM; 81% email/social media), call for test results (71.5% texting; 75% VM; 65% email/social media), medication reminders (63% texting; 54% VM; 58% e-mail/social media), and health tips (36% texting; 18.5% VM; 73% email/social media). Cell-based health-related communication with adolescents is feasible even within low socioeconomic status populations, primarily via texting. Health providers should embrace cell-based patient communication.
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Affiliation(s)
- Anju Sawni
- 1 Hurley Children's Hospital/Hurley Medical Center, Flint, MI, USA.,2 Michigan State University College of Human Medicine, E Lansing, MI, USA
| | - Crystal Cederna-Meko
- 1 Hurley Children's Hospital/Hurley Medical Center, Flint, MI, USA.,2 Michigan State University College of Human Medicine, E Lansing, MI, USA
| | - Jenny L LaChance
- 1 Hurley Children's Hospital/Hurley Medical Center, Flint, MI, USA.,2 Michigan State University College of Human Medicine, E Lansing, MI, USA
| | - Angie Buttigieg
- 2 Michigan State University College of Human Medicine, E Lansing, MI, USA.,3 George Washington University, Washington, DC, USA
| | - Quoc Le
- 2 Michigan State University College of Human Medicine, E Lansing, MI, USA.,4 University of Cincinnati, Cincinnati, OH, USA
| | - Irene Nunuk
- 2 Michigan State University College of Human Medicine, E Lansing, MI, USA.,5 Stanford University, Palo Alto, CA, USA
| | - Joyce Ang
- 2 Michigan State University College of Human Medicine, E Lansing, MI, USA.,6 Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine M Burrell
- 1 Hurley Children's Hospital/Hurley Medical Center, Flint, MI, USA.,2 Michigan State University College of Human Medicine, E Lansing, MI, USA
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Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients. J Pediatr Adolesc Gynecol 2017; 30:76-81. [PMID: 27543001 DOI: 10.1016/j.jpag.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Providing adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices. DESIGN Participating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality. SETTING Nine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites. PARTICIPANTS Forty-four physicians. INTERVENTIONS Provider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions. MAIN OUTCOME MEASURES Improvement in confidentiality standards met during minor adolescent well visits. RESULTS Participating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001). CONCLUSIONS A medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.
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127
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Rand CM, Vincelli P, Goldstein NPN, Blumkin A, Szilagyi PG. Effects of Phone and Text Message Reminders on Completion of the Human Papillomavirus Vaccine Series. J Adolesc Health 2017; 60:113-119. [PMID: 27836533 DOI: 10.1016/j.jadohealth.2016.09.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the effect of phone or text message reminders to parents of adolescents on human papillomavirus (HPV) vaccine series completion in Rochester, NY. METHODS We performed parallel randomized controlled trials of phone and text reminders for HPV vaccine for parents of 11- to 17-year olds in three urban primary care clinics. The main outcome measures were time to receipt of the third dose of HPV vaccine and HPV vaccination rates. RESULTS We enrolled 178 phone intervention (180 control) and 191 text intervention (200 control) participants. In multivariate survival analysis controlling for gender, age, practice, insurance, race, and ethnicity, the time from enrollment to receipt of the third HPV dose for those receiving a phone reminder compared with controls was not significant overall (hazard ratio [HR] = 1.30, p = .12) but was for those enrolling at dose 1 (HR = 1.91, p = .007). There was a significant difference in those receiving a text reminder compared with controls (HR = 2.34, p < .0001; an average of 71 days earlier). At the end of the study, 48% of phone intervention versus 40% of phone control (p = .34), and 49% of text intervention versus 30% of text control (p = .001) adolescents had received 3 HPV vaccine doses. CONCLUSIONS In this urban population of parents of adolescents, text message reminders for HPV vaccine completion for those who had already started the series were effective, whereas phone message reminders were only effective for those enrolled at dose 1.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Phyllis Vincelli
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nicolas P N Goldstein
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Aaron Blumkin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California
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128
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Nitardy CM, Duke NN, Pettingell SL, Borowsky IW. Racial and Ethnic Disparities in Preventive Care: An Analysis of Routine Physical Examination Among Adolescents, 1998-2010. Clin Pediatr (Phila) 2016; 55:1338-1345. [PMID: 26888965 DOI: 10.1177/0009922816632180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Routine health care plays a central role in health promotion and disease prevention for children and in reducing health disparities. The purpose of this study is to examine the prevalence of routine physical examination among racially and ethnically diverse adolescents at 5 different time points. The study used data from the Minnesota Student Survey. Measures include frequency of physical examination by race/ethnicity, poverty status, and family structure. The analytic sample included 351 510 adolescents (1998, n = 67 239; 2001, n = 69 177; 2004, n = 71 084; 2007, n = 72 312; and 2010, n = 71 698). There were significant differences by racial/ethnic group at each time point. For example, in 2010, never having a physical examination was reported by 9.2% American Indian, 8.7% Asian American/Pacific Islander, 7.0% Hispanic/Latino, 4.3% Black/African American, 3.7% mixed race, and 2.6% of White respondents ( P < .001). Patterns of association emerged when the measure of routine physical examination was stratified by poverty and family structure.
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129
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Jasik CB, Berna M, Martin M, Ozer EM. Teen Preferences for Clinic-Based Behavior Screens: Who, Where, When, and How? J Adolesc Health 2016; 59:722-724. [PMID: 27884300 DOI: 10.1016/j.jadohealth.2016.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous research examining computer-based adolescent risk behavior screening was done before widespread adoption of smartphones and merits updating. METHODS This is a cross-sectional survey among 115 adolescents seeking primary care age 12-18 years. It is a diverse sample with 59% female, 51% white, 18% African-American, and 27% Latino. Respondents were asked level of comfort and honesty (1 = strongly disagree, 5 = strongly agree) when answering health behavior questions by paper, interview, or electronic device. Differences in the level of agreement were tested using a Wilcoxon signed rank test. RESULTS Adolescents reported a higher level of comfort and honesty for screening conducted via electronic device versus paper (90% vs. 57%, p < .001; 89% vs. 61%, p < .001). Sixty-two percent adolescents prefer waiting room electronic screening versus at home (4.7%) or by provider in the examination room (11.2%). CONCLUSIONS Electronic same-day risk behavior screening is the preferred method for adolescents and should be incorporated into preventive services.
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Affiliation(s)
- Carolyn Bradner Jasik
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California.
| | - Mark Berna
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California
| | - Maria Martin
- The Ohio State University School of Medicine, Columbus, Ohio
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California; UCSF Office of Diversity and Outreach, University of California, San Francisco, California
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130
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Hadland SE, Yehia BR, Makadon HJ. Caring for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Inclusive and Affirmative Environments. Pediatr Clin North Am 2016; 63:955-969. [PMID: 27865338 PMCID: PMC5119916 DOI: 10.1016/j.pcl.2016.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth may experience interpersonal and structural stigma within the health care environment. This article begins by reviewing special considerations for the care of LGBTQ youth, then turns to systems-level principles underlying inclusive and affirming care. It then examines specific strategies that individual providers can use to provide more patient-centered care, and concludes with a discussion of how clinics and health systems can tailor clinical services to the needs of LGBTQ youth.
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Affiliation(s)
- Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Baligh R Yehia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn Medicine Program for LGBT Health, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Harvey J Makadon
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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131
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Seetharaman S, Yen S, Ammerman SD. Improving adolescent knowledge of emergency contraception: challenges and solutions. Open Access J Contracept 2016; 7:161-173. [PMID: 29386948 PMCID: PMC5683156 DOI: 10.2147/oajc.s97075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Globally, unintended adolescent pregnancies pose a significant burden. One of the most important tools that can help prevent unintended pregnancy is the timely use of emergency contraception (EC), which in turn will decrease the need for abortions and complications related to adolescent pregnancies. Indications for the use of EC include unprotected sexual intercourse, contraceptive failure, or sexual assault. Use of EC is recommended within 120 hours, though is most effective if used as soon as possible after unprotected sex. To use EC, adolescents need to be equipped with knowledge about the various EC methods, and how and where EC can be accessed. Great variability in the knowledge and use of EC around the world exists, which is a major barrier to its use. The aims of this paper were to 1) provide a brief overview of EC, 2) discuss key social determinants affecting knowledge and use of EC, and 3) explore best practices for overcoming the barriers of lack of knowledge, use, and access of EC.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sophia Yen
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Seth D Ammerman
- Division of Adolescent Medicine, Stanford University Medical Center, Palo Alto, CA, USA
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132
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Zickafoose JS, Ireys HT, Swinburn A, Simpson LA. Primary Care Physicians' Experiences With and Attitudes Toward Pediatric Quality Reporting. Acad Pediatr 2016; 16:750-759. [PMID: 27452883 PMCID: PMC5847285 DOI: 10.1016/j.acap.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess primary care providers' experiences with and attitudes toward pediatric-focused quality reports and identify key associated physician/practice characteristics. METHODS We performed a cross-sectional survey of pediatricians and family physicians providing primary care to publicly insured children in 3 states (North Carolina, Ohio, Pennsylvania). The survey included questions about receipt of pediatric quality reports, use of reports for quality improvement (QI), and beliefs about the effectiveness of reports for QI. We used multivariable analyses to assess associations between responses and physician/practice characteristics, including exposure to federally funded demonstration projects aimed at increasing quality reporting to physicians serving publicly insured children. We supplemented these analyses with a thematic investigation of data from 46 interviews with physicians, practice staff, and state demonstration staff. RESULTS Seven hundred twenty-seven physicians responded to the survey (overall response rate: 45.2%). Most physicians were receiving quality reports related to pediatric care (79.8%; 95% confidence interval [CI], 77.2%-82.4%) and believed that quality reports can be effective in helping guide QI (70.5%; 95% CI, 67.5%-73.5%). Fewer used quality reports to guide QI efforts (32.5%; 95% CI, 29.5%-35.6%). There were no significant associations between demonstration exposure and experiences or attitudes. Interview data suggested that physicians were receptive to quality reporting, but significant barriers remain to using such reports for QI, such as limited staff time or training in QI. CONCLUSIONS Although pediatric quality reporting is considered a promising strategy, in this study, state efforts appeared insufficient to overcome the barriers to using reports to guide practice-based QI.
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Affiliation(s)
| | - Henry T Ireys
- Mathematica Policy Research and AcademyHealth, Washington, DC
| | | | - Lisa A Simpson
- Mathematica Policy Research and AcademyHealth, Washington, DC
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133
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Ma M, Malcolm L, Diaz-Albertini K, Klinoff VA. HIV Testing Characteristics Among Hispanic Adolescents. J Community Health 2016; 41:11-4. [PMID: 26093652 DOI: 10.1007/s10900-015-0056-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hispanic adolescents are disproportionally impacted by HIV/AIDS. Among Hispanic people living with HIV, delayed testing and late entry into HIV care have been documented. The current study examined Hispanic adolescents' HIV testing characteristics and factors related to testing. Adolescents aged 13-16 (N = 223) completed a survey on HIV testing motivation, perceptions, and experience, sexual behavior, and substance use. Results indicate few adolescents (9%) had taken an HIV test. Among those who have not been tested, 32.5% expressed interest in testing. HIV testing was favorably perceived with 82.4% reported testing should be done with all youth or those are sexually active. Adolescents who had engaged in high risk behaviors (history of sexual intercourse, substance use) were more likely to have been tested or to express interest in testing. Given that HIV testing is positively perceived by Hispanic adolescents, prevention efforts should focus on minimizing barriers and enhancing accessibility to HIV screening.
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Affiliation(s)
- Mindy Ma
- College of Psychology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA.
| | - Lydia Malcolm
- College of Psychology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
| | - Kristine Diaz-Albertini
- College of Psychology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
| | - Vera A Klinoff
- College of Psychology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
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134
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Syverson EP, McCarter R, He J, D'Angelo L, Tuchman LK. Adolescents' Perceptions of Transition Importance, Readiness, and Likelihood of Future Success: The Role of Anticipatory Guidance. Clin Pediatr (Phila) 2016; 55:1020-5. [PMID: 27582491 DOI: 10.1177/0009922816666882] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Expert consensus supports anticipatory guidance around health care transition (HCT), but little is known about its impact on adolescents' perceptions of HCT. This study aimed to evaluate the frequency of HCT anticipatory guidance delivery and the effect it had on participants' perceptions of HCT. Adolescents (n = 209) with special health care needs were administered National Survey for Children with Special Health Care Needs transition assessment questions, then reported perceptions of transition importance, readiness, and likely future success. Over half of the participants reported no history of discussion about transition to an adult provider (64%) or insurance needs (67%); just under half (43%) had not discussed their changing health care needs. In participants reporting receipt of anticipatory guidance, ratings of transition readiness and future success were significantly higher than those who received no anticipatory guidance, supporting that HCT anticipatory guidance has a significantly positive impact on adolescents' perceptions of the HCT process.
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Affiliation(s)
| | | | - Jianping He
- Children's National Medical Center, Washington, DC, USA
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135
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Moreno MA, Arseniev-Koehler A, Selkie E. Development and Testing of a 3-Item Screening Tool for Problematic Internet Use. J Pediatr 2016; 176:167-172.e1. [PMID: 27395768 PMCID: PMC5636184 DOI: 10.1016/j.jpeds.2016.05.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/09/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop and validate the Problematic and Risky Internet Use Screening Scale (PRIUSS)-3 screening scale, a short scale to screen for Problematic Internet Use. STUDY DESIGN This scale development study applied standard processes using separate samples for training and testing datasets. We recruited participants from schools and colleges in 6 states and 2 countries. We selected 3 initial versions of a PRIUSS-3 using correlation to the PRIUSS-18 score. We evaluated these 3 potential screening scales for conceptual coherence, factor loading, sensitivity, and specificity. We selected a 3-item screening tool and evaluated it in 2 separate testing sets using receiver operating curves. RESULTS Our study sample included 1079 adolescents and young adults. The PRIUSS-3 included items addressing anxiety when away from the Internet, loss of motivation when on the Internet, and feelings of withdrawal when away from the Internet. This screening scale had a sensitivity of 100% and specificity of 69%. A score of ≥3 on the PRIUSS-3 was the threshold to follow up with the PRIUSS-18. DISCUSSION Similar to other clinical screening tools, the PRIUSS-3 can be administered quickly in a clinical or research setting. Positive screens should be followed by administering the full PRIUSS-18. Given the pervasive presence of the Internet in youth's lives, screening and counseling for Problematic Internet Use can be facilitated by use of this validated screening tool.
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Affiliation(s)
- Megan A. Moreno
- Seattle Children's Research Institute; Center for Child Health, Behavior and Development, PO Box 5371, Seattle, WA 98145-5005, (206) 884-1424
| | | | - Ellen Selkie
- University of Michigan, Department of Pediatrics, (734) 232-9962
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136
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Dittus PJ. Promoting Adolescent Health Through Triadic Interventions. J Adolesc Health 2016; 59:133-4. [PMID: 27448946 PMCID: PMC6742423 DOI: 10.1016/j.jadohealth.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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137
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Abstract
This update of the 2008 statement from the American Academy of Pediatrics redirects the discussion of quality health care from the theoretical to the practical within the medical home. This statement reviews the evolution of the medical home concept and challenges the provision of quality adolescent health care within the patient-centered medical home. Areas of attention for quality adolescent health care are reviewed, including developmentally appropriate care, confidentiality, location of adolescent care, providers who offer such care, the role of research in advancing care, and the transition to adult care.
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138
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Loosier PS, Doll S, Lepar D, Ward K, Gamble G, Dittus PJ. Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings. THE JOURNAL OF SCHOOL HEALTH 2016; 86:595-603. [PMID: 27374349 PMCID: PMC10150609 DOI: 10.1111/josh.12414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 01/21/2016] [Accepted: 03/30/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage indicated Project Connect was successful with sexually experienced female youth, where it increased rates of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing and receipt of contraception. This adaption of Project Connect examined its effectiveness in a new context and via collection of clinic encounter-level data. METHODS Project Connect was implemented in 3 high schools. (only 2 schools remained open throughout the entire project period). Participant recruitment and data collection occurred in 5 of 8 participating health clinics. Students completed Youth Surveys (N = 608) and a Clinic Survey (paired with medical data abstraction in 2 clinics [N = 305]). RESULTS Students were more likely than nonstudents to report having reached a clinic via Project Connect. Nearly 40% of students attended a Project Connect school, with 32.7% using Project Connect to reach the clinic. Students were most likely to have been referred by a school nurse or coach. CONCLUSIONS Project Connect is a low-cost, sustainable structural intervention with multiple applications within schools, either as a standalone intervention or in combination with ongoing efforts.
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Affiliation(s)
- Penny S Loosier
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E02, Atlanta, GA 30333.
| | - Shelli Doll
- HIV Care and Prevention Section, Michigan Department of Health and Human Services, Lansing, MI 48913.
| | - Danielle Lepar
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Kristin Ward
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Ginger Gamble
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Patricia J Dittus
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E44, Atlanta, GA 30333.
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139
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Rasberry CN, Liddon N, Adkins SH, Lesesne CA, Hebert A, Kroupa E, Rose ID, Morris E. The Importance of School Staff Referrals and Follow-Up in Connecting High School Students to HIV and STD Testing. J Sch Nurs 2016; 33:143-153. [PMID: 27418443 DOI: 10.1177/1059840516658695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.
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Affiliation(s)
- Catherine N Rasberry
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Liddon
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hocevar Adkins
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Elana Morris
- 4 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Garcia-Huidobro D, Shippee N, Joseph-DiCaprio J, O’Brien JM, Svetaz MV. Effect of Patient-Centered Medical Home on Preventive Services for Adolescents and Young Adults. Pediatrics 2016; 137:peds.2015-3813. [PMID: 27244851 PMCID: PMC5553307 DOI: 10.1542/peds.2015-3813] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the association between enrollment in patient-centered medical homes (PCMHs) and the receipt of preventive services among adolescents and young adults. METHODS Retrospective cohort study including patients of Hennepin County aged 10 to 24 who had face-to-face or telephone encounters with health care providers between 2010 and 2014 at clinics with PCMHs at the Hennepin County Medical Center, Minnesota. Exposure was enrollment in PCMHs. Outcomes were receipt of (1) preventive visits; (2) prescriptions for influenza, meningococcal, and human papillomavirus vaccinations; (3) screening for sexually transmitted infections; (4) prescription of any contraceptive and long-acting reversible contraceptives; and (5) cervical cancer screening. Generalized mixed effect models in a propensity-score-matched sample were used for data analysis. RESULTS Overall, 21 704 patients were included. Most patients were female, US-born, Hispanic/Latino, with an average age of 20.8 years. Patients enrolled in PCMH (n = 729) were more likely to be Latino, students, and have health insurance (P < .001). Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive services of patients enrolled in PCMHs to youth who did not receive these services were as follows: (1) preventive visits 1.10 (0.93-1.29); (2) influenza 0.89 (0.74-1.07), meningococcal 1.53 (1.30-1.80), and human papillomavirus vaccinations 1.53 (1.28-1.84); (3) screening for sexually transmitted infections 1.69 (1.28-2.24); (4) prescription of any type of contraception 2.18 (1.56-3.03) and long-acting reversible contraceptives 2.66 (1.89-3.74); and (5) cervical cancer screening 1.14 (0.87-1.48). CONCLUSIONS Overall, patients enrolled in PCMHs had higher odds of receiving multiple preventive services.
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Affiliation(s)
- Diego Garcia-Huidobro
- Aqui Para Ti/Here for You, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, and Department of Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Nathan Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota; and
| | | | | | - Maria Veronica Svetaz
- Aqui Para Ti/Here for You,,Henne-teen, and,Department of Family and Community Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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141
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Dixon SK, Hoopes AJ, Benkeser D, Grigg A, Grow HM. Characterizing Key Components of a Medical Home Among Rural Adolescents. J Adolesc Health 2016; 58:141-7. [PMID: 26802989 DOI: 10.1016/j.jadohealth.2015.10.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/01/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents in rural areas have higher unmet medical needs and receive fewer preventive health care visits than their urban counterparts. This community health assessment aimed to describe adolescent experiences of key components of a medical home in rural Washington. METHODS A cross-sectional survey using questions from two validated measures was created with input from a community advisory group using community-based participatory research principles. The survey was administered to a convenience sample of high-school students in one rural town. Responses within each medical home domain were grouped to create composite scores. Linear and logistic regression analyses identified characteristics associated with receiving medical home services. RESULTS A total of 217 adolescents aged 13-19 years completed the survey. Eighty-five percent identified as Latino/Hispanic. Respondents described usually or always feeling listened to by providers (80%), respected by providers (89%), and welcomed at their clinic (79%). Fewer reported having a personal health provider (56%), meeting alone with a provider (56%), or knowing the visit was confidential (60%). Those who identified having a primary provider had 2.48 greater odds (95% confidence interval = 1.13-5.45) of reporting a well visit in the previous year and had higher composite scores for compassionate and patient-centered care. CONCLUSIONS This sample of rural adolescents reported receiving many characteristics of a medical home but had limited experience with personal providers and confidential services. Improving adolescent access to confidential care may be especially important in small, rural communities. The association of a primary provider with improved medical home experience highlights this key characteristic in an adolescent medical home.
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Affiliation(s)
- Sarah K Dixon
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Andrea J Hoopes
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - David Benkeser
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Aaron Grigg
- Department of Pediatrics, University of Washington, Seattle, Washington; Yakima Valley Farm Workers Clinic, Toppenish, Washington
| | - H Mollie Grow
- Department of Pediatrics, University of Washington, Seattle, Washington.
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142
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Aalsma MC, Gilbert AL, Xiao S, Rickert VI. Parent and Adolescent Views on Barriers to Adolescent Preventive Health Care Utilization. J Pediatr 2016; 169:140-5. [PMID: 26681476 DOI: 10.1016/j.jpeds.2015.10.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 09/04/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine adolescent and parent views of barriers to annual adolescent preventive care. STUDY DESIGN A nationally recruited cross-sectional study of adolescents between ages 13 and 18 years, and parents of adolescents from different families, were recruited. The primary outcome was self-report of preventive care in the last 12 months. Demographic, family health discussions, physical/emotional health importance, and preventive care barriers were gathered from adolescents and parents. RESULTS The majority of the sample (500 adolescents and 504 parents in different families) reported a primary care visit within 12 months (parents = 78.7%; adolescents = 66.9%). Adolescent participants identified more barriers than parents (parents = 0.69; adolescents = 1.42). Adolescent who reported having discussions with parents about health (aOR 1.57, 95% CI 1.26-1.98) and seeing a subspecialist provider (aOR 3.72, CI 1.21-11.47) were more likely to report preventive visits. Barriers for parents and adolescents include the belief that an appointment is only needed when a child is sick (parent aOR 0.21, CI 0.08-0.61; adolescent aOR 0.29, CI 0.17-0.51) and family cannot afford cost (parent aOR 0.34, CI 0.15-0.81; adolescent aOR 0.50, CI 0.26-0.97). Barriers for parents include the child sees a specialist (aOR 0.26, CI 0.08-0.88) and their child does not need a checkup (aOR 0.12, CI 0.05-0.34). Lastly, a barrier for adolescents was parents never schedule preventive visits (aOR 0.31, CI 0.17-0.58). CONCLUSIONS The Affordable Care Act has the potential to limit preventive care barriers. The results of the current study find there are parental and adolescent issues regarding preventive services that should be addressed.
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Affiliation(s)
| | | | - Shan Xiao
- Indiana University School of Medicine, Indianapolis, IN
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143
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Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions. Matern Child Health J 2015; 19:790-7. [PMID: 25047785 DOI: 10.1007/s10995-014-1570-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.
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144
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Yen S, Parmar DD, Lin EL, Ammerman S. Emergency Contraception Pill Awareness and Knowledge in Uninsured Adolescents: High Rates of Misconceptions Concerning Indications for Use, Side Effects, and Access. J Pediatr Adolesc Gynecol 2015; 28:337-42. [PMID: 26148784 DOI: 10.1016/j.jpag.2014.09.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To determine the awareness of, access to, and knowledge of the proper use of emergency contraception pills (ECPs) among uninsured adolescents. DESIGN Anonymous surveys were used to assess awareness of, knowledge of, and access to ECPs. SETTING From 2010 to 2012 at mobile primary care clinic in the San Francisco Bay Area. PARTICIPANTS Patients were uninsured adolescents aged 13 to 25; 40% of the participants were currently or had been homeless in the past year. Ethnicity was 50% Asian, 22% Hispanic, 17% Pacific Islanders, 5.5% white, and 5.5% other/mixed ethnicity. INTERVENTIONS Post survey completion, patients received one-on-one 15-minute dedicated ECP education. MAIN OUTCOME MEASURES Awareness of, knowledge of, and access to ECPs. RESULTS Of the study population of 439, 30% of the participants were 13-16 years old and 70% were 17-25 years old (mean age 17.8 years); 66% were women. Young women (86%) reported higher rates of "hearing about emergency contraception" than did young men (70%) (P < .0001). Many incorrectly identified or were uncertain if ECPs were an abortion pill (40%) or could be used as regular birth control (40%) or to prevent sexually transmitted infections (19%). Only 40% of women and 43% of men aged 17 and older correctly answered that they could obtain EC over the counter; 72% did not know that males could receive EC for use by their partner; 12% incorrectly selected that infertility was a side effect; 44% were under the false impression that EC had to be taken within 1 day of unprotected sex. CONCLUSIONS Uninsured adolescents have high rates of ECP awareness but low ECP knowledge. These adolescents need more ECP education to alleviate misconceptions and increase practical knowledge, specifically, education about male access, side effects, over-the-counter availability for young men and women, and the 120-hour window of use.
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Affiliation(s)
- Sophia Yen
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University Medical School, Lucile Packard Children's Hospital Stanford, Mountain View, California
| | - Deepika D Parmar
- University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri
| | - Emily L Lin
- Washington University in St. Louis, St Louis, Missouri
| | - Seth Ammerman
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University Medical School, Lucile Packard Children's Hospital Stanford, Mountain View, California.
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145
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Rand CM, Blumkin A, Vincelli P, Katsetos V, Szilagyi PG. Parent Preferences for Communicating With Their Adolescent's Provider Using New Technologies. J Adolesc Health 2015; 57:299-304. [PMID: 26299557 DOI: 10.1016/j.jadohealth.2015.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/26/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Because adolescents make few health care visits, we assessed the views of parents of adolescents on various means to communicate with their adolescents' physicians about vaccine reminders and appointments, medication refills and test results-including phone, mail, e-mail, text messages, and personal health records (PHRs). METHODS We performed a cross-sectional survey of 400 parents of adolescents presenting to four pediatric offices (two urban, two suburban) in Rochester, NY in 2011 before vaccine reminders occurring in these practices. RESULTS Roughly half of parents (60% urban, 52% suburban, p = .11) were accepting of teens receiving their own vaccine reminders. Urban parents preferred communicating with the provider via telephone, whereas suburban parents preferred e-mail for most issues and a PHR for receipt of test results. In adjusted analyses, being younger was associated with preferring text message vaccine reminders (41 to <51 years: adjusted relative risk [aRR] = .8, p = .02; ≥51 years, aRR = .5, p < .001), and being a suburban parent was associated with preferring e-mail reminders (aRR = 1.6, p < .001). Those who were younger (41 to <51 years: aRR = .6, p = .007; ≥51 years: aRR = .4, p < .001) and suburban (aRR = 2.4, p < .001) were most likely to be interested in general use of a PHR. CONCLUSIONS Our study shows that some, but not all, parents are ready for electronic (text message, e-mail, PHR) communications for their adolescents' health care and that a parent age and socioeconomic divide exists. Providing options in the means in which parents communicate with an adolescent's provider is ideal.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York.
| | - Aaron Blumkin
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Phyllis Vincelli
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Viki Katsetos
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California
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146
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Victor EC, Chung R, Thompson RJ. Identifying Adolescent Patients at Risk for Sexually Transmitted Infections: Development of a Brief Sexual Health Screening Survey. Clin Pediatr (Phila) 2015; 54:878-87. [PMID: 25527529 DOI: 10.1177/0009922814563273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the association between survey responses to health behaviors, personality/psychosocial factors, and self-reported sexually transmitted infections (STIs) to create a brief survey to identify youth at risk for contracting STIs. Participants included 200 racially diverse 14- to 18-year-old patients from a pediatric primary care clinic. Two sexual behavior variables and one peer norm variable were used to differentiate subgroups of individuals at risk of contracting a STI based on reported history of STIs using probability (decision tree) analyses. These items, as well as sexual orientation and having ever had oral sex, were used to create a brief sexual health screening (BSHS) survey. Each point increase in total BSHS score was associated with exponential growth in the percentage of sexually active adolescents reporting STIs. Findings suggest that the BSHS could serve as a useful tool for clinicians to quickly and accurately detect sexual risk among adolescent patients.
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147
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Adams SH, Park MJ, Irwin CE. Adolescent and Young Adult Preventive Care: Comparing National Survey Rates. Am J Prev Med 2015; 49:238-47. [PMID: 25935503 DOI: 10.1016/j.amepre.2015.02.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Affordable Care Act's preventive healthcare provisions have the potential to increase adolescents' and young adults' receipt of recommended preventive services. Assessing whether this potential is realized requires valid monitoring data in several areas, including receipt of an annual preventive visit. The purpose of this study is to describe and compare preventive visit rates across national surveys for adolescents and young adults. METHODS This study, conducted in 2014: (1) identified national surveys with past-year preventive visit measures; (2) compared survey features, including mode of administration, respondent, response rate, demographic profile (univariate analysis), preventive visit measure wording, and method of construction; and (3) compared preventive visit rates, including rates among sociodemographic subgroups (bivariate analyses). RESULTS Four 2011 surveys were identified: National Health Interview Survey, National Survey of Children's Health (2011-2012), and Medical Expenditure Panel Survey (MEPS) for adolescents, and MEPS and Behavioral Risk Factor Surveillance System for young adults. Surveys varied by most assessed features; demographic profiles were similar. Preventive visit rates varied significantly across adolescents (43%-81%) and young adults (26%-58%). The largest differences in visit rates were in comparisons of subjective assessments to a more detailed assessment coded from specific records of visits kept by respondents. Sociodemographic differences in visit rates were consistent across surveys. CONCLUSIONS Further research is needed to assess reasons for the different estimates of preventive visits across national surveys. Those who monitor trends in receipt of recommended care for adolescents and young adults should take survey differences into account. Monitoring content of care is also needed.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, California.
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, California
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148
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Seburg EM, McMorris BJ, Garwick AW, Scal PB. Disability and Discussions of Health-Related Behaviors Between Youth and Health Care Providers. J Adolesc Health 2015; 57:81-6. [PMID: 25953137 DOI: 10.1016/j.jadohealth.2015.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to examine the likelihood of discussing health-related behaviors with health care providers (HCPs), comparing youth with and without mobility limitations (MLs). METHODS Analyses were conducted using baseline data from the MyPath study. Adolescents and young adults between the ages of 16 and 24 years completed a survey about their health care and health-related experiences. Analyses assessed the relationship between mobility status and discussing health-related behaviors with an HCP. Secondary analyses examined the extent to which adolescents and young adults' engagement in these behaviors was associated with these discussions. RESULTS Overall, we found low rates of discussions about the following topics: substance use, sexual and reproductive health, healthy eating, weight, and physical activity. Adolescents and young adults with MLs were less likely to report discussing substance use and sexual and reproductive health, but were more likely to discuss healthy eating, weight, and physical activity than peers without MLs. Those adolescents and young adults who reported substance use had higher odds of discussing this topic and those who reported having sexual intercourse had higher odds of discussing sexual and reproductive health. CONCLUSIONS Results suggest mobility status and a young person's engagement in health risk and promoting behaviors are associated with the likelihood of discussing these behaviors with an HCP. It is important that HCPs view adolescents and young adults with MLs as needing the same counseling and guidance about health-related behaviors as any young person presenting him/herself for treatment.
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Affiliation(s)
- Elisabeth M Seburg
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | | | - Ann W Garwick
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Peter B Scal
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota
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149
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Improving Interdisciplinary Professionals’ Capacity to Motivate Adolescent Behavior Change. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2015.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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150
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Chlamydia screening for sexually active young women under the Affordable Care Act: new opportunities and lingering barriers. Sex Transm Dis 2015; 41:538-44. [PMID: 25118966 DOI: 10.1097/olq.0000000000000170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Affordable Care Act of 2010 (ACA) contains a provision requiring private insurers issuing or renewing plans on or after September 23, 2010, to provide, without cost sharing, preventive services recommended by US Preventive Services Task Force (grades A and B), among other recommending bodies. As a grade A recommendation, chlamydia screening for sexually active young women 24 years and younger and older women at risk for chlamydia falls under this requirement. This article examines the potential effect on chlamydia screening among this population across private and public health plans and identifies lingering barriers not addressed by this legislation. Examination of the impact on women with private insurance touches upon the distinction between coverage under grandfathered plans, where the requirement does not apply, and nongrandfathered plans, where the requirement does apply. Acquisition of private health insurance through health insurance Marketplaces is also discussed. For public health plans, coverage of preventive services without cost sharing differs for individuals enrolled in standard Medicaid, covered under the Medicaid expansion included in the ACA, or those enrolled under the Children's Health Insurance Program or who fall under Early, Periodic, Screening, Diagnosis and Treatment criteria. The discussion of lingering barriers not addressed by the ACA includes the uninsured, physician reimbursement, cost sharing, confidentiality, low rates of appropriate sexual history taking by providers, and disclosures of sensitive information. In addition, the role of safety net programs that provide health care to individuals regardless of ability to pay is examined in light of the expectation that they also remain a payer of last resort.
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